Communication strategies for Alzheimer's
Dementia doesn’t define someone; it’s important to remember that the person you love is still there when they are living with dementia, it’s just you may have to work a little harder and use different communication strategies to bring them to the fore. Dementia damages the ‘memory centre’ of the brain, the hippocampus, however the ‘emotion centre’ (called the amygdala) is largely unaffected, so while the person may not be able to recall that you visited that morning, they’ll still get the feeling of love and warmth that you inspired in them when you were there.
Therefore, it’s important to remember that even if your loved one doesn’t remember your name or who you are, they will never lose the feeling that you bring out in them when they hear your voice or feel the touch of your skin, so if you can do nothing more, talk to them and hold their hand – it may work wonders.
Don’t speak to them like you would a child
The majority of people living with dementia are over the age of 65, so they’ll have a wealth of life experience behind them. Even though they may not be able to recall everything they’ve lived through, it is important to respect the fact that they’ve lived that life, and not treat them like a child. As a person’s dementia journey progresses they will most likely become less able to do things for themselves and they will require more and more support, but they are still the adult who brought you up and tended to you when you were young, and even though roles may have been reversed, they are not a child and should still be respected appropriately.
It’s important that carers also ensure that they don’t patronise their customer, even though it’s in their nature to be protective of someone they’re looking after. There is after all, a fine line between caring for someone while encouraging their independence, and doing everything for them, which however well-meaning, will ultimately do more harm than good.
Use their name or preferred titles
It’s respectful to use a person’s title until you know otherwise, and when our carers visit their customers for the first time they are always reminded that they should use ‘Mr’ or ‘Mrs’ (or appropriate) until they know that the customer would prefer to be called by their first name. Even though social conventions may have changed in more recent years, when the customer was young they would probably never have dreamt of addressing someone of their parents’ age or older by their first names and it would be easy to offend someone you’re meeting for the first time to presume that it’s okay to do so.
Not everyone likes to be touched, especially by someone they don’t know so well, and for carers it would be best to take the loved ones’ leads on whether their new customer would like it or not. As a family member though, you are a link to the emotions that the person is still able to tap into and experience, even when their dementia is becoming advanced. Touch is something we crave from birth and most of us are lucky enough to be held and stroked by our parents and loved ones, so as a person’s dementia advances it’s no surprise that being touched can help to reduce anxiety and also help the person feel loved and secure.
Touching is also a key aspect of non-verbal communication which may develop as the person becomes unable to communicate in more traditional forms, so provided the person is comfortable with you and being touched, it can be a beneficial way to communicate.
Don’t talk loudly
Hearing can be affected by dementia, meaning that the way a person is able to process sound changes. Loud noises and too many different sounds at once can be uncomfortable and frightening for someone living with dementia, as instead of them all being separated by the brain they all come in at one intensity which can be extremely unpleasant and unnerving. The Alzheimer’s Society recommend “Make sure you’re in a good place to communicate.
Ideally, it will be quiet and calm, with good lighting. Busy environments can make it especially difficult for a person with dementia to concentrate on the conversation, so turn off distractions such as the radio or TV.” If there is more than one of you with the person it can also be helpful to nominate just one of you to do the talking, as too many voices can also be confusing for someone with dementia to follow.
Don’t speak in slang or metaphors
Speaking plainly and directly will help someone living with dementia to follow a conversation more easily. Using modern slang words can cause confusion, as their brain may have regressed to an earlier time of their life where such words didn’t exist, leading to even less understanding and more additional distress. If the person grew up speaking a language that they didn’t use in later life they may well have begun communicating in that language again, which can be difficult for family or carers who may not speak it too.
If that’s the case, see if you can use a translation programme on a phone, or even better, perhaps there is someone in the neighbourhood who speaks the language and could help? Be wary about bringing people they don’t know into the home though, as this in itself can heighten distress levels and anxiety in some cases. If in doubt, talk to one of the person’s multi-agency team, such as the Admiral nurse, GP, or a charity such as Alzheimer’s Society. Helping Hands also has a team of dementia experts in the company, so speak to the local manager for advice any time you need it.
Patience is the most important aspect of caring for someone living with dementia in general, but it’s even more important when communicating. It can be frustrating for the person’s loved-ones and carers when the person strugglers to communicate or asks the same questions over again, however there’s always a reason for it, and the person themselves may be feeling even more frustrated than you are. Dementia can erase the ability to recall short-term memory, so it makes sense that if you want to know the time you’ll ask the question, having no recollection that you actually did the same thing a few seconds earlier.
Position yourself at their level
Being at someone’s eye level is a respectful way to speak to anyone, and people know that to talk to people who use a wheelchair it is polite to crouch down or sit at the same level as them. This is also important for people living with dementia, as it can be even more crucial to try and make a connection through non-verbal means for someone who is struggling to communicate in more traditional ways. Eye level is also important if you are trying to encourage someone living with dementia to eat or drink for instance, as they will often mirror your behaviour if you put yourself in their eyeline and make meaningful eye contact when eating or drinking.
Eyesight may also be degrading as their dementia journey progresses, so making sure they can actually see you is another reason to ensure you are in their direct eyeline. It’s important to respect boundaries of personal space though and not crowd the person.
It can be very hard for loved ones when the realities of a dementia diagnosis become more obvious and it’s understandable why families may live with some level of difficulty believing that the diagnosis is accurate. This could manifest in many ways, but one could be prompting the person to answer questions about their life and what has happened more recently, perhaps to reassure themselves that their loved one isn’t as affected as they’ve been told.
Trying to get someone who is living with dementia to answer questions can be very distressing for them though, as if they are unable to recall the information that the other person is seeking they can become frustrated and agitated with themselves and the other person. For instance, instead of asking “Did you have a nice walk in the park this morning?” which may upset the person as they don’t recall they went to the park that day, you could try something like “I hear you went to the park this morning. Was it sunny?” which is a much narrower question and may give the person something to focus on when trying to recall where they went.
If this doesn’t work though it would then be easier to distract away to a topic such as the roses they can see out of the window or the fact it’s raining, or whatever’s relevant at that moment.
Smile and make eye contact
Smiling is a universal symbol that transcends all languages and cultures. It will also help to put someone with dementia at ease when you are communicating with them non-verbally. The Alzheimer’s Society reminds us that “the person with dementia will read and interpret your body language. Sudden movements, the tone of your voice or a tense facial expression can upset or distress them, even if the words you say are not upsetting.” Consequently, smiling and making sure that you are always conveying a pleasant facial expression will put the person at ease and ensure that they get as much reassurance from you being there as possible.
Eye contact is also respectful and a way of showing the person that you value what they’re saying and that you’re listening, as well as being vital for making a connection in non-verbal communication.
Page reviewed by Carole Kerton-Church, Regional Clinical Lead on November 23, 2021